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Tuschick E, Barker J, Giles EL, Jones S, Hogg J, Kanmodi KK, Sill J, Sykes K. Barriers and facilitators for people with severe mental illness accessing cancer screening: A systematic review. Psychooncology 2024; 33:e6274. [PMID: 38282230 DOI: 10.1002/pon.6274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Evidence suggests that people with severe mental illness (PwSMI) are 2.1 times more likely to die from cancer before the age of 75, compared to people without Severe mental illness (SMI). Yet, cancer screening uptake is low among PwSMI. This mixed-methods systematic review aimed to identify the barriers and facilitators for PwSMI deciding to access and attend primary cancer screening of the cervix, breast and colon. METHODS Six electronic databases and two grey literature sources were searched, with 1017 records screened against inclusion criteria. Included papers were appraised and data synthesised using the constructs of Normalisation Process Theory. RESULTS Twenty papers met the inclusion criteria. Factors that impact upon uptake of PwSMI accessing cancer screening were found to include age, gender, race, and income. Common barriers to attending screening included poor communication from healthcare staff, stigmatising attitudes, and accessibility problems such as no access to transportation. While, facilitators included social support from friends, family, and healthcare providers. CONCLUSIONS Due to ease and privacy, colorectal screening was found to have fewer barriers when compared to cervical and breast screening. The review identified multiple barriers that can be addressed and targeted to support decision-making for cancer screening among PwSMI. The protocol was registered with PROSPERO (CRD42022331781).
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Affiliation(s)
- Emma Tuschick
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Jill Barker
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Emma L Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Susan Jones
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Julie Hogg
- Library Services, Teesside University, Middlesbrough, UK
| | - Kehinde K Kanmodi
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Jula Sill
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Kate Sykes
- Northumbria University, Newcastle Upon Tyne, UK
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Sayani A, Vahabi M, O'Brien MA, Liu G, Hwang SW, Selby P, Nicholson E, Lofters A. Perspectives of family physicians towards access to lung cancer screening for individuals living with low income - a qualitative study. BMC FAMILY PRACTICE 2021; 22:10. [PMID: 33413135 PMCID: PMC7791696 DOI: 10.1186/s12875-020-01354-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS. METHODS A theory-informed thematic analysis was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens. RESULTS Four overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes. CONCLUSION An equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.
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Affiliation(s)
- Ambreen Sayani
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Mary Ann O'Brien
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Erika Nicholson
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Aisha Lofters
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Department of Family Medicine, Women's College Hospital, Toronto, Ontario, Canada
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Abstract
OBJECTIVE: Adults with serious mental illnesses have a lower life expectancy attributable to many factors including metabolic disorders and cancer. Access to cancer screening has been shown to decrease morbidity and increase chances of survival. This study examined access to cancer screening services among individuals with serious mental illnesses served by a community behavioral health care agency partial hospitalization program at four locations. METHOD: A self-administered paper-and-pencil survey was provided to adults attending partial hospitalization programs. The survey consisted of open- and closed-ended questions about utilization, access to, and barriers to cervical, breast, and colorectal cancer screenings. RESULTS: Surveys were completed by 136 individuals. Participant screening rates were above national rates for cervical and breast cancer but lower for colorectal cancer. The main cited barrier to receiving the screening tests was lack of physician recommendations. CONCLUSIONS: Psychiatric nurses are ideally suited to communicate with this population and other behavioral health care professions about the importance of these screenings. Communication should also advocate for improved education and increased support for cancer screenings to address this health care disparity.
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Affiliation(s)
- Lois Rockson
- Lois Rockson, MPH, MAEd, SCT (ASCP), Rutgers University, Newark, NJ, USA
| | - Margaret Swarbrick
- Margaret Swarbrick, PhD, FAOTA, University Behavioral Healthcare, Piscataway, NJ, USA; Collaborative Support Programs of New Jersey, Freehold, NJ, USA
| | - Carlos Pratt
- Carlos Pratt, PhD, CPRP, Rutgers University, Scotch Plains, NJ, USA
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Asgary R. Cancer screening in the homeless population. Lancet Oncol 2018; 19:e344-e350. [PMID: 30084381 DOI: 10.1016/s1470-2045(18)30200-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 01/05/2023]
Abstract
Annually, 100 million people experience homelessness worldwide. Most adults that are struggling with homelessness are living to age 50 years or older and need age-appropriate screening for cancer. Cancer-related death in homeless adults is twice as high as the average in the adult population in the USA. However, few studies have examined the rates of and barriers to cancer screening in homeless people. This Review explores cancer-related health disparities between homeless people and the general population by providing a review of data and definitions relating to homelessness, an analysis of barriers to screening in this population, and a discussion of the current and potential interventions and strategies to improve cancer screening in homeless individuals. Recommendations include implementing appropriate data collection methods for this population, supporting cancer screening in places where homeless people usually access care, assessing the effectiveness of approaches to increasing cancer screening in homeless people, and addressing adequate housing as a fundamental social factor.
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Affiliation(s)
- Ramin Asgary
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA; Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; Department of Population and Family Studies, Mailman School of Public Health of Columbia University, New York, NY, USA; Doctors Without Borders-USA, New York, NY, USA.
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Moravac CC. Reflections of Homeless Women and Women with Mental Health Challenges on Breast and Cervical Cancer Screening Decisions: Power, Trust, and Communication with Care Providers. Front Public Health 2018; 6:30. [PMID: 29600243 PMCID: PMC5863503 DOI: 10.3389/fpubh.2018.00030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/29/2018] [Indexed: 11/13/2022] Open
Abstract
This study conducted in Toronto, Canada, explored the perceptions of women living in homeless shelters and women with severe mental health challenges about the factors influencing their decision-making processes regarding breast and cervical cancer screening. Twenty-six in-depth qualitative interviews were conducted. The objectives of this research were (i) to provide new insights about women's decision-making processes, (ii) to describe the barriers to and facilitators for breast and cervical cancer screening, and (iii) to offer recommendations for future outreach, education, and screening initiatives developed specifically for under/never-screened marginalized women living in urban centers. This exploratory study utilized thematic analysis to broaden our understanding about women's decision-making processes. A constructed ontology was used in an attempt to understand and describe participants' constructed realities. The epistemological framework was subjective and reflected co-created knowledge. The approach was hegemonic, values-based, and context-specific. The aim of the analysis was to focus on meanings and actions with a broader view to identify the interplay between participants' narratives and social structures, medical praxis, and policy implications. Results from 26 qualitative interviews conducted in 2013-2014 provided insights on both positive and negative prior cancer screening experiences, the role of power and trust in women's decision-making, and areas for improvement in health care provider/patient interactions. Outcomes of this investigation contribute to the future development of appropriately designed intervention programs for marginalized women, as well as for sensitivity training for health care providers. Tailored and effective health promotion strategies leading to life-long cancer screening behaviors among marginalized women may improve clinical outcomes, decrease treatment costs, and save lives.
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Lamontagne-Godwin F, Burgess C, Clement S, Gasston-Hales M, Greene C, Manyande A, Taylor D, Walters P, Barley E. Interventions to increase access to or uptake of physical health screening in people with severe mental illness: a realist review. BMJ Open 2018; 8:e019412. [PMID: 29440160 PMCID: PMC5829934 DOI: 10.1136/bmjopen-2017-019412] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/15/2017] [Accepted: 12/07/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify and evaluate interventions aimed at increasing uptake of, or access to, physical health screening by adults with severe mental illness; to examine why interventions might work. DESIGN Realist review. SETTING Primary, secondary and tertiary care. RESULTS A systematic search identified 1448 studies, of which 22 met the inclusion criteria. Studies were from Australia (n=3), Canada (n=1), Hong Kong (n=1), UK (n=11) and USA (n=6). The studies focused on breast cancer screening, infection preventive services and metabolic syndrome (MS) screening by targeting MS-related risk factors. The interventions could be divided into those focusing on (1) health service delivery changes (12 studies), using quality improvement, randomised controlled trial, cluster randomised feasibility trial, retrospective audit, cross-sectional study and satisfaction survey designs and (2) tests of tools designed to facilitate screening (10 studies) using consecutive case series, quality improvement, retrospective evaluation and pre-post audit study designs. All studies reported improved uptake of screening, or that patients had received screening they would not have had without the intervention. No estimation of overall effect size was possible due to heterogeneity in study design and quality. The following factors may contribute to intervention success: staff and stakeholder involvement in screening, staff flexibility when taking physical measurements (eg, using adapted equipment), strong links with primary care and having a pharmacist on the ward. CONCLUSIONS A range of interventions may be effective, but better quality research is needed to determine any effect size. Researchers should consider how interventions may work when designing and testing them in order to target better the specific needs of this population in the most appropriate setting. Behaviour-change interventions to reduce identified barriers of patient and health professional resistance to screening this population are required. Resource constraints, clarity over professional roles and better coordination with primary care need to be addressed.
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Affiliation(s)
| | - Caroline Burgess
- Primary Care and Public Health Sciences, King's College London, London, UK
| | | | | | - Carolynn Greene
- College of Nursing, Midwifery and Healthcare, University of West London, London, UK
| | - Anne Manyande
- School of Human and Social Sciences, University of West London, London, UK
| | - Deborah Taylor
- College of Nursing, Midwifery and Healthcare, University of West London, London, UK
| | - Paul Walters
- Department of Research and Development, Dorset HealthCare University NHS Foundation Trust, Bournemouth, UK
| | - Elizabeth Barley
- School of Human and Social Sciences, University of West London, London, UK
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Hunt BR, Allgood K, Sproles C, Whitman S. Metrics for the systematic evaluation of community-based outreach. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:633-8. [PMID: 23857186 DOI: 10.1007/s13187-013-0519-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
There is an extensive literature on the use of community-based outreach for breast health programs. While authors often report that outreach was conducted, there is rarely information provided on the effort required for outreach. This paper seeks to establish a template for the systematic evaluation of community-based outreach. We describe three types of outreach used by our project, explain our evaluation measures, present data on our outreach efforts, and demonstrate how these metrics can be used to inform a project's decisions about which types of outreach are most effective.
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Affiliation(s)
- Bijou R Hunt
- Sinai Urban Health Institute, Mount Sinai Hospital, 1500 S. California Ave, Chicago, IL, 60608, USA,
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Williams A, Erb-Downward J, Bruzelius E, O'Hara-Cicero E, Maling A, Machin L, Viera-Delgado M, Valera P, Maysonet N, Weiss ES. Exploring cancer screening in the context of unmet mental health needs: a participatory pilot study. Prog Community Health Partnersh 2013; 7:123-34. [PMID: 23793243 DOI: 10.1353/cpr.2013.0027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cancer is the leading cause of preventable death in the Bronx, New York. Service providers in this mental health provider shortage area identified untreated mental illness as an important barrier to participation in cancer screening, a finding that supports existing literature. The Mental Health and Cancer (MHC) Connection partnership formed to investigate and address this issue. OBJECTIVES We sought to use an ecological framework to examine barriers and facilitators to obtaining mental health services in the Bronx, and to explore how lack of access to mental healthcare affects cancer screening. METHODS In this community-based participatory research (CBPR)-driven pilot study, semistructured, qualitative interviews based on an ecological framework were conducted with 37 Bronx-based service providers representing a range of professional perspectives. Data were analyzed using thematic content analysis and techniques from grounded theory. RESULTS Similar barriers and facilitators were reported for mental healthcare and cancer screening utilization across ecological levels. Providers emphasized the impact of urban poverty-related stressors on the mental health of their clients, and affirmed that mental health issues were a deterrent for cancer screening. They also recognized their own inability to connect clients effectively to cancer screening services, and rarely saw this as part of their present role. CONCLUSIONS Findings highlight how unmet mental health needs can affect cancer screening in impoverished urban contexts. Participants recommended improving linkages across healthcare and social service providers to address mental health and cancer screening needs simultaneously. Study results are being used to plan a collaborative intervention in the Bronx through the MHC Connection partnership.
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Affiliation(s)
- Abigail Williams
- Division of Community Collaboration and Implentation Science, Albert Einstein College of Medicine, Department of Epidemiology and Population Health
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Fitzpatrick-Lewis D, Ganann R, Krishnaratne S, Ciliska D, Kouyoumdjian F, Hwang SW. Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review. BMC Public Health 2011; 11:638. [PMID: 21831318 PMCID: PMC3171371 DOI: 10.1186/1471-2458-11-638] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on interventions to positively impact health and housing status of people who are homeless has received substantially increased attention over the past 5 years. This rapid review examines recent evidence regarding interventions that have been shown to improve the health of homeless people, with particular focus on the effect of these interventions on housing status. METHODS A total of 1,546 articles were identified by a structured search of five electronic databases, a hand search of grey literature and relevant journals, and contact with experts. Two reviewers independently screened the first 10% of titles and abstracts for relevance. Inter-rater reliability was high and as a result only one reviewer screened the remaining titles and abstracts. Articles were included if they were published between January 2004 and December 2009 and examined the effectiveness of an intervention to improve the health or healthcare utilization of people who were homeless, marginally housed, or at risk of homelessness. Two reviewers independently scored all relevant articles for quality. RESULTS Eighty-four relevant studies were identified; none were of strong quality while ten were rated of moderate quality. For homeless people with mental illness, provision of housing upon hospital discharge was effective in improving sustained housing. For homeless people with substance abuse issues or concurrent disorders, provision of housing was associated with decreased substance use, relapses from periods of substance abstinence, and health services utilization, and increased housing tenure. Abstinent dependent housing was more effective in supporting housing status, substance abstinence, and improved psychiatric outcomes than non-abstinence dependent housing or no housing. Provision of housing also improved health outcomes among homeless populations with HIV. Health promotion programs can decrease risk behaviours among homeless populations. CONCLUSIONS These studies provide important new evidence regarding interventions to improve health, housing status, and access to healthcare for homeless populations. The additional studies included in this current review provide further support for earlier evidence which found that coordinated treatment programs for homeless persons with concurrent mental illness and substance misuse issues usually result in better health and access to healthcare than usual care. This review also provides a synthesis of existing evidence regarding interventions that specifically support homeless populations with HIV.
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Affiliation(s)
- Donna Fitzpatrick-Lewis
- The Effective Public Health Practice Project, School of Nursing, McMaster University, Hamilton, Canada
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Hanson K, Montgomery P, Bakker D, Conlon M. Evaluation of an intervention designed to recruit Canadian women to mammography screening. J Community Health Nurs 2011; 28:130-43. [PMID: 21809929 DOI: 10.1080/07370016.2011.589230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Mammography screenings have the potential to reduce mortality; unfortunately, participation rates remain below federally established targets. To increase screening, the Ontario Breast Screening Program (OBSP) implemented a mammography recruitment intervention that involved a locally designed postcard. The first phase of this descriptive study involved the distribution of a questionnaire to determine how attendees became aware of the OBSP. Semistructured telephone interviews were conducted in the study's second phase to describe breast screening attendees' perceptions of the postcard campaign. Although the participants positively appraised the postcard initiative, it played a minor role in comparison to typical OBSP recruitment methods.
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Affiliation(s)
- Kim Hanson
- School of Nursing, Laurentian University, Sudbury, Ontario, Canada
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Weingart SN, Saadeh MG, Simchowitz B, Gandhi TK, Nekhlyudov L, Studdert DM, Puopolo AL, Shulman LN. Process of care failures in breast cancer diagnosis. J Gen Intern Med 2009; 24:702-9. [PMID: 19387748 PMCID: PMC2686776 DOI: 10.1007/s11606-009-0982-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 02/12/2009] [Accepted: 03/30/2009] [Indexed: 12/28/2022]
Abstract
BACKGROUND Process of care failures may contribute to diagnostic errors in breast cancer care. OBJECTIVE To identify patient- and provider-related process of care failures in breast cancer screening and follow-up in a non-claims-based cohort. DESIGN Retrospective chart review of a cohort of patients referred to two Boston cancer centers with new breast cancer diagnoses between January 1, 1999 and December 31, 2004. PARTICIPANTS We identified 2,275 women who reported > or =90 days between symptom onset and breast cancer diagnosis or presentation with at least stage II disease. We then selected the 340 (14.9%) whose physicians shared an electronic medical record. We excluded 238 subjects whose records were insufficient for review, yielding a final cohort of 102 patients. INTERVENTIONS None MEASUREMENTS We tabulated the number and types of process of care failures and examined risk factors using bivariate analyses and multivariable Poisson regression. MAIN RESULTS Twenty-six of 102 patients experienced > or =1 process of care failure. The most common failures occurred when physicians failed to perform an adequate physical examination, when patients failed to seek care, and when diagnostic or laboratory tests were ordered but patients failed to complete them. Failures were attributed in similar numbers to provider- and patient-related factors (n = 30 vs. n = 25, respectively). Process of care failures were more likely when the patient's primary care physician was male (IRR 2.8, 95% CI 1.2 to 6.5) and when the patient was non-white (IRR 2.8, 95% CI 1.4 to 5.7). CONCLUSIONS Process failures were common in this patient cohort, with both clinicians and patients contributing to breakdowns in the diagnostic process.
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Affiliation(s)
- Saul N Weingart
- Center for Patient Safety, Dana-Farber Cancer Institute, 44 Binney St., Boston, MA, 02115, USA.
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Magee C, Huriaux E. Ladies' night: evaluating a drop-in programme for homeless and marginally housed women in San Francisco's mission district. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:113-21. [PMID: 18313280 DOI: 10.1016/j.drugpo.2007.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 11/14/2007] [Accepted: 11/19/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gender, race, class, and sexuality create a unique set of requirements for addressing HIV risk among homeless and marginally housed (HMH) women. Though studies have recommended both individual and structural prevention strategies tailored to meet the expansive needs of this community, there is a paucity of research on interventions specific to HMH women. Ladies' Night is a service-rich drop-in programme for HMH women in San Francisco's Mission District. METHODS In 2006, an exploratory evaluation was conducted to examine the programme's benefits and challenges and identify opportunities to advocate for participants. The evaluation was grounded in ethnography and social network theory. It used three qualitative data collection tools in its methodology: (1) interviews with 5 providers and 8 participants; (2) a self-administered survey completed by 7 participants; and (3) observation field notes from 9 Ladies' Night sessions. RESULTS Evaluation findings demonstrate the following: (1) as a harm reduction-based program, Ladies' Night provides safety and social support for programme participants, fosters positive change and promotes health; and (2) the programme has two significant challenges-the social context of participants' lives and resource limitations that affect service provision. CONCLUSION Recommendations call for allocation of resources to support: (1) sustainable women-specific services for HMH women in San Francisco; and (2) consistent assessment and evaluation of those services.
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Affiliation(s)
- Catherine Magee
- Women's Community Clinic, 2166 Hayes Street, Suite 104, San Francisco, CA 94117, USA.
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Davis MM, Gance-Cleveland B, Hassink S, Johnson R, Paradis G, Resnicow K. Recommendations for prevention of childhood obesity. Pediatrics 2007; 120 Suppl 4:S229-53. [PMID: 18055653 DOI: 10.1542/peds.2007-2329e] [Citation(s) in RCA: 313] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The majority of US youth are of healthy weight, but the majority of US adults are overweight or obese. Therefore, a major health challenge for most American children and adolescents is obesity prevention-today, and as they age into adulthood. In this report, we review the most recent evidence regarding many behavioral and practice interventions related to childhood obesity, and we present recommendations to health care providers. Because of the importance, we also suggest approaches that clinicians can use to encourage obesity prevention among children, including specific counseling strategies and practice-based, systems-level interventions. In addition, we suggest how clinicians may interact with and promote local and state policy initiatives designed to prevent obesity in their communities.
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Affiliation(s)
- Matthew M Davis
- Child Health Evaluation and Research Unit, Division of General Pediatrics, Gerald R. Ford School of Public Policy, Arizona State University, Phoenix, Arizona, USA.
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